Perceived Barriers to Employment Among Latinos with Schizophrenia and Their Family Members

Purpose: Employment is recognized as an important component of rehabilitation for individuals with schizophrenia.  Despite studies demonstrating substantial benefits, most individuals with schizophrenia are not employed. It is estimated that rates of employment are as low as 17.2% and even lower among groups such as Latinos. Therefore, examining barriers to employment experienced by Latinos with schizophrenia can provide a better understanding of the unique challenges faced by this underserved group. Furthermore, because most Latinos with this illness live with family, assessing family members’ perspectives can provide new insights into the role of the family context regarding employment. This study explored barriers to employment among Latinos with schizophrenia and their family members receiving community-based mental health services.

Methods: Data came from the qualitative component of an NIMH-funded follow-up study on Latinos with schizophrenia and their low-acculturated, Spanish-speaking family members. Purposive sampling was used to select participants (N = 34) for follow-up interviews. Fourteen clients and 20 family members were interviewed in their preferred language on more than one occasion by bilingual–bicultural interviewers. One client was engaged in competitive employment and one in a sheltered setting. Semistructured in-depth interviews were analyzed using thematic analysis, which consisted of comparing codes across and within client and family member transcripts. After independent coding by team members, results were compared to reach consensus. A codebook was developed and memo-writing was used throughout the analysis process to document decisions regarding theme development. Additionally, several established strategies to assess rigor were used.

Results: Analysis revealed that participants perceived numerous challenges to employment that centered on the following themes: (1) feelings of inadequacy due to symptoms (“I became nervous, thought I couldn’t do it, so I left”); (2) lack of flexibility and accommodations (“It was difficult to work at night, so the next day I quit”) (3) stigma (“He doesn’t have to go around saying [I have schizophrenia]”); (4) lack of awareness of how to access employment resources (“[We need] a program that would take them to work and bring them back”); and (5) fear of losing government assistance (“I don’t know how that works”). Despite barriers, families supported clients in their efforts to pursue employment by providing opportunities for skill development, e.g., “I take him to work with me.”

Implications: Participants were primarily concerned with how symptoms could interfere with vocational responsibilities, resulting in uncertainty about performance. In addition, participants who sought work encountered inflexible work settings that did not accommodate their needs and added to their perceptions of stigma. Moreover, some participants expressed concern about loss of benefits due to employment. Findings underscore the need to examine barriers to implementation of supported employment due to participants’ lack of awareness or access to such evidence-based treatment. In particular, due to Latino families’ close involvement, it is important for practitioners to inform and provide direct support in a culturally congruent manner to achieve employment objectives.